Improvement of Respiratory Symptoms Following Heller Myotomy for Achalasia

Abstract

A Heller myotomy is effective in improving esophageal emptying in patients with achalasia. This results in sustained improvement of dysphagia and associated respiratory symptoms/diseases. This suggests that respiratory symptoms/diseases in these patients are likely caused by esophageal retention of food and secretions, and then aspiration.

Achalasia and Respiratory Symptoms: Effect of Laparoscopic Heller Myotomy

“…The frequency and severity of all respiratory symptoms decreased significantly, and 82% of patients who reported a history of pneumonia before surgery did not experience recurrent episodes for up to 5 years after the operation. 14 Our study has some limitations. The first is its retrospective nature and the lack of long-term follow-up.…”

“…While in the past it was thought that respiratory symptoms were rarely associated with achalasia, today it is evident that 40%-50% of patients may also experience cough, dyspnea, asthma, hoarseness, aspiration, and pneumonia. 3,4,[12][13][14] Recently, Makharia et al studied with pulmonary function tests and high-resolution computed tomography (HRCT) 30 patients with esophageal achalasia. 4 Seventeen patients had dry cough (56.6%).…”

“…The second mechanism is instead micro-or macroaspiration of esophageal contents into the tracheobronchial tree. [3][4][5][6][7][11][12][13][14] If this is indeed the main cause, either pneumatic dilatation or Heller myotomy should improve or resolve these symptoms by eliminating the functional obstruction at the level of the gastroesophageal junction and improving esophageal emptying.…”

“…2 While in the past it was thought that achalasia rarely caused respiratory symptoms, today there is mounting evidence suggesting that cough, wheezing, hoarseness, and pneumonia are frequently present, and they are probably caused by episodes of micro-or macroaspiration of the retained food and secretions in the esophagus. [3][4][5][6][7][8][9][10][11][12][13][14] The goal of our study was to determine: (1) what percentage of achalasia patients experience respiratory symptoms; (2) what factors play a role in the genesis of these symptoms; and (3) the effect of Heller myotomy on dysphagia, regurgitation, and respiratory symptoms.…”

Retrospective analysis of paediatric achalasia in India: Single centre experience

“…Gastrostomy, besides helping in healing of perforation by diverting acidic juices, also decreases the risk of aspiration pneumonia in post-operative period because of acquired oesophageal dysmotality in achalasia. [22,34,35] We had used chest infection instead of chest pain in scoring (contrary to Eckerd's scoring) because latter symptom is difficult to interpret in the children. [16,18,19] The scoring used by us was semiquantitative and can be obtained from parents' by simple questionnaire by mail also.…”